Managing and reducing sickness absence

Reducing sickness, absence has emerged as a strong feature of the Governments and HSC's strategy for occupational health (OH) called 'Securing Health Together'.

The strategy forms a key part of the Government's overall approach to 'revitalising' OS&H.

It is clear that the HSC are now moving well beyond the traditional view of OH (preventing health damage due to work/taking account of health in fitting workers to jobs) and encouraging a broader view which sees this subject as primarily a management, rather than a medical, matter.

RoSPA has also stressed that while the imbalance between safety and health should be redressed, both needed to be addressed by organisations as a management issue, using a common H&S management system framework.

The broad aims of 'Securing Health Together' are to reduce work related ill health (WRIH) and absenteeism, to meet needs for job adaptation and rehabilitation following illness or injury (whether caused by work or not), to reduce ill health and disability barriers in the labour market and to promote the use of the workplace as an area for health improvement and encouraging changes in lifestyle.

Targets are set for a 20 per cent reduction in WRIH (for workers and the public) and a 30 per cent reduction in days off due to WRIH by 2010 as well as universal access to job adjustment and rehabilitation by the end of the decade.

There will also be a stronger focus on improving employee welfare, particularly by encouraging more family friendly policies as well as a renewed effort to remove barriers to employment of those currently on invalidity benefit. (The aim here is to combat social exclusion but there is clearly a Treasury interest in reducing the current cost of invalidity benefit, said to be over £70 billion per annum.)

The big traditional OH issues however remain the prevention of musculo-skeletal injury, particularly back injury and WRULDS, stress and stress linked ill health, dermatitis, deafness, vibration injury, asthma, particularly respiratory sensitisation and cancer etc.

What RoSPA has been trying to determine is what is the average scope for reducing sickness absence by better OH and welfare policies? The HSE view seems to be that, not only is the work-related component of overall sickness absence underestimated in most organisations, but that there is major scope for helping people, particularly the long term sick, to return to work by making simple job adjustments. But given a certain incidence of general ill health in the population of working age, how realistic are the claims being made by HSE?

Available literature, including a recent Chartered Institute of Personnel and Development (CIPD) survey report based on 1700 responses by its members to a questionnaire about sickness absence rates, its causes and the perceived efficacy of various interventions has revealed that stress, headaches, colds, flu, stomach upsets predominated as the main causes of self certificated absence. Accidents (whether occupational accidents or not) are only a small part of the overall picture. About half of all sickness absence was due to long term health problems as opposed to short episodes.

Opinions varied between CIPD members responding to the survey as to how much of self-certificated sickness absence was actually due to the causes given by employees. Although hard evidence was not presented to support this, many said that up to half of self-certification was due to low morale or taking time off to deal with family sickness.

Opinions also varied as to the best way of reducing sickness absence. Some seem to have evidence that robust 'return to work' interview and disciplinary procedures helped. Others claimed success for morale boosting measures and additional steps such as family friendly policies, confidential counselling, health promotion, rehabilitation etc.

The average rate of sickness absence from the survey across the whole economy was 4.1 per cent of total working time (9.3 days per employee) with a top rate of about 6 per cent in health, local government etc. and a lowest rate of about 2 per cent in mining and quarrying. Clearly the economic cost for the economy as a whole is massive.

The survey also showed a marked difference in absence rates according to size of organisation, with small firms showing lower absence rates. This reflects similar findings from the HSE's "Self Reported Work Related Illness Survey 1998/ 99" about the prevalence of minor reportable occupational injury in small firms. For example workers in a manufacturing firm employing less than 50 employees are twice as likely to suffer a fatal or major injury compared to workers in a firm employing 1000 plus. On the other hand, the rate of absences of more than three days due to non fatal/ major occupational injury in small firms is roughly half that in large ones. Various explanations are proffered for this e.g. less generous sick pay arrangements, less slack in teams, the need to tackle urgent work, more team spirit and so on.

What the CIPD's findings seem to suggest is that, quite apart from the question of totally unjustifiable sickness absence (about which anecdotage abounds but where there have been few good studies), individual differences in the experience of ill-health and in motivation obviously play a big part in determining whether injury or sickness converts to absence. Clearly individual perceptions of discomfort and distress (associated with the common causes of self certificated absence: colds, flu, headaches, gastro-intestinal problems, depression, back ache) vary enormously from one person to another. One employee may continue to come to work with a heavy cold or clinical depression; another may not feel able to do so. Also, there can clearly be a link between employee health and family sickness (e.g. where employees suffer stress due to the illness of a child or become depressed following bereavement or divorce.)

The true pattern of causes underlying employee absence is quite clearly a rich and complex one and consequently there are dangers in any over simple analysis, particularly if it leads to even more simplistic prescriptions. Thus the real challenge for any organisation wanting to reduce absence seems to be how to tailor a set of cost effective policies which will produce a best fit for the majority of staff while at the same time still meeting individual needs.

There is obviously a wide range of measures or interventions which can be taken to reduce absence, including:

• clearly defined policies, rules and induction processes;
• effective communication of corporate vision and mission;
• good appraisal, target setting, support, supervision etc.;
• appropriate staff training;
• sound OH programmes and good OS&H management (including stress);
• specific morale boosting (team building) measures;
• family friendly policies (flexibility to deal with family needs, crises etc);
• general health screening plus well woman/ man initiatives;
• wider health promotion initiatives (alcohol, diet, exercise, smoking etc.);
• return-to-work interviews;
• rehabilitation/ physiotherapy etc.;
• confidential counselling in specific cases (viz unexplained absence patterns);
• other measures such as Employee Assistance Programmes; and so on.

At the same time, while many of these may seem desirable (where they are affordable and practicable), few good studies are currently available to provide robust evidence of their efficacy, either singly or in combination.

From a health standpoint, organisations have to tread a fine line between enhancing motivation in those who are already highly motivated but whose health might actually be damaged by attending work when they should be recovering or seeking medical help and encouraging those who might be tempted to take time off when faced with significant discomfort but for whom attendance at work (with support, for example) might actually aid their recovery. This latter approach is very much a key message in the Government's 'Back in Work' campaign where job adjustments for sufferers from chronic back pain, supported by access to treatment, are seen as a better approach than their being signed off work and becoming resigned to incapacity.

From this point of view, across-the board, policies (particularly coercive policies) targeted at those taking allegedly unjustified sickness absence, while impacting this group, may actually damage health in more highly motivated groups as well as reduce overall morale and thus be counterproductive. Targeted and employee specific approaches delivered through line management are more likely to be cost effective.

There is also the question, still not much discussed, of tackling 'presenteeism'. That is, those who may be putting their health at risk by working excessive hours, not taking their full leave entitlement or generally damaging their health and well being by failing to achieve a correct life/ work balance. (This is going to be the subject of a further major Government initiative). Allowing people to burn the candle at both ends is bad for individuals and is ultimately bad for business (leading to problems with quality, error, interpersonal relations, ill health, loss of key staff etc.) and should be actively discouraged.

There are a variety of established guidance texts that are perceived as reflecting good practice in attendance management (CIPD, Industrial Society etc.) but it seems likely that approaches to managing absence due to sickness are likely to continue to evolve as this issue becomes located within a wider OH and welfare framework.

One of the issues on which managers will need specific guidance is the analysis of sickness absence data, understanding its significance, for example, (in the light of the gender, age, social class etc. profile of any particular group). In general, managers tend to have a limited understanding of health issues, including patterns of morbidity in the general population but clearly a basic understanding of 'observed over expected' is required, for example, if they are to identify any problems that may be occupationally related or if they are to identify the available margins within which particular approaches may prove cost/effective in reducing absence. Beyond that there is the question of how to evaluate impact. In small organisations particularly, simple analyses of absence data will tend to be statistically unreliable and thus more qualitative approaches will be required.

Given the acknowledged need to enhance managers' competence to tackle OH issues (particularly in areas like stress, manual handling etc), there would seem to be a very strong case for new training courses and materials looking specifically at best practice in this area. The catch phrase for managing sickness absence seems to be - make sure workers are 'happy, healthy and here'.